Diabetes care in the U.S. consistently fails to meet recommended quality standards. Barriers impede the translation of evidence-based guidelines into sustainable practice. Few studies have considered multiple barriers, and there is a lack of evidence-based strategy in choosing interventions to overcome barriers. This proposal involves a comprehensive assessment of practice barriers to diabetes guidelines adherence across a primary care network. A Barrier Assessment Tool (BAT) based upon a framework proposed by Cabana, et al. (1999) will be validated to correlate with provider and practice adherence to diabetes care guidelines. A Diabetes Flow Sheet implemented in our Network to track adherence to guidelines will be assessed and correlated with measured barriers. This organizational strategy will support an evidence-based approach to quality initiative interventions. The BAT will be administered to practice team members: providers, support staff, and practice managers in our network of 25 primary care practices. Five hypotheses are tested: [unreadable] A: The BAT measures perceived barriers to adherence to diabetes guidelines, while showing adequate internal consistency and an identifiable subscale structure. [unreadable] B: The BAT results inversely correlate with practice and provider adherence to ADA guidelines. [unreadable] C: BAT scores will inversely correlate with use of the Diabetes Flow Sheet. [unreadable] D: The BAT scores inversely correlate with clinical outcomes (glycemic and lipid control.) [unreadable] E: Use of the Diabetes Flow Sheet correlates with higher provider & practice adherence to ADA guidelines. [unreadable] The BAT would then provide the structure for comprehensive assessment of barriers. Study of the [unreadable] effectiveness of interventions targeted to barriers would be the next step in future projects and research. [unreadable] The Crozer-Keystone PBRN is a real-world laboratory for research in the translation of evidence into diverse practices. The Network became an AHRQ-funded PBRN in 2002 and has just completed a randomized intervention in the care of chronic disease patients. The Crozer-Keystone Health Network Quality Committee infrastructure has historically supported guideline adherence and diffusion of evidence-based medicine into practices. The Network is optimally positioned to implement and study this proposed organizational strategy. [unreadable] [unreadable] [unreadable]